Mental health problems and the presentation of minor illnesses: data from a 30-year follow-up in general practice.
BACKGROUND
Somatic comorbidity in patients with depression and anxiety is very prevalent and mainly studied with respect to chronic conditions. Patients with mental health problems are high utilizers of medical care. This may be a result of their functional impairment and illness behaviour, but also of their interpretation of common symptoms and their attitude towards healthcare. Therefore, we expect that patients with mental health problems are more likely to present with minor illnesses to the general practitioner.


OBJECTIVE
To assess the association of minor illnesses with depression and anxiety.


METHODS
A historic cohort study in a general practice database of 13,500 patients, with more than 30 years' follow-up. Three prevalent categories of minor illnesses were assessed: skin, musculoskeletal, and respiratory disorders. We studied the number of patients with a diagnosis of a minor illness in patients with depression and anxiety disorder compared with their matched controls.


RESULTS
We found 799 patients with depression and 153 patients with anxiety disorder. More patients with depression present skin, musculoskeletal, and respiratory disorders in the year before and the years following the initial diagnosis of depression. Depression appeared to be statistically significantly associated with presenting all three types of minor illnesses. More patients with anxiety disorder present skin and respiratory disorders in the year before diagnosis, and more musculoskeletal disorders in the years following the diagnosis of anxiety disorder. Anxiety disorder appeared to be statistically significantly associated with presenting skin and musculoskeletal morbidity.


CONCLUSIONS
Compared to controls, more patients with depression and anxiety disorder present minor illnesses. This could be due to their high attendance rate, altered illness behaviour, or to factors--e.g., stress--underlying both the development of depression or anxiety and the susceptibility to diseases.
Olde Hartman
Tim
T
Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. t.oldehartman@hag.umcn.nl
van Rijswijk
Eric
E
van Ravesteijn
Hiske
H
Hassink-Franke
Lieke
L
Bor
Hans
H
van Weel-Baumgarten
Evelyn
E
Lucassen
Peter
P
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology*; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D012871:Skin Diseases / Q000453:epidemiology*